title: Predictors of stroke recurrence in patients with recent lacunar stroke and response to interventions according to risk status: secondary prevention of small subcortical strokes trial.
abstract: BACKGROUND
  Among participants in the Secondary Prevention of Small Subcortical Strokes randomized trial, we sought to identify patients with high versus low rates of recurrent ischemic stroke and to assess effects of aggressive blood pressure control and dual antiplatelet therapy according to risk status.
  
  
  METHODS
  Multivariable analyses of 3020 participants with recent magnetic resonance imaging-defined lacunar strokes followed for a mean of 3.7 years with 243 recurrent ischemic strokes.
  
  
  RESULTS
  Prior symptomatic lacunar stroke or transient ischemic attack (TIA) (hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.6, 2.9), diabetes (HR 2.0, 95% CI 1.5, 2.5), black race (HR 1.7, 95% CI 1.3, 2.3), and male sex (HR 1.5, 95% CI 1.1, 1.9) were each independently predictive of recurrent ischemic stroke. Recurrent ischemic stroke occurred at a rate of 4.3% per year (95% CI 3.4, 5.5) in patients with prior symptomatic lacunar stroke or TIA (15% of the cohort), 3.1% per year (95% CI 2.6, 3.9) in those with more than 1 of the other 3 risk factors (27% of the cohort), and 1.3% per year (95% CI 1.0, 1.7) in those with 0-1 risk factors (58% of the cohort). There were no significant interactions between treatment effects and stroke risk status.
  
  
  CONCLUSIONS
  In this large, carefully followed cohort of patients with recent lacunar stroke and aggressive blood pressure management, prior symptomatic lacunar ischemia, diabetes, black race, and male sex independently predicted ischemic stroke recurrence. The effects of blood pressure targets and dual antiplatelet therapy were similar across the spectrum of independent risk factors and recurrence risk.
authors.affiliation: Department of Medicine (Neurology), McMaster University, Hamilton, Ontario, Canada. Electronic address: robert.hart@phri.ca.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hart
authors.affiliation: Biostatistics Consultant, Minot, North Dakota.
authors.forename: Lesly A
authors.initials: LA
authors.lastname: Pearce
authors.affiliation: Department of Neurology, Taiba University, Medina, Saudi Arabia.
authors.forename: Majid F
authors.initials: MF
authors.lastname: Bakheet
authors.affiliation: Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Oscar R
authors.initials: OR
authors.lastname: Benavente
authors.affiliation: National Institute of Neurological Disorders and Stroke, Rockville, Maryland.
authors.forename: Robin A
authors.initials: RA
authors.lastname: Conwit
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
authors.affiliation: Department of Clinical Pharmacy, University of Texas, Austin, Texas.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Talbert
authors.affiliation: Department of Neurology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: David C
authors.initials: DC
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D055502:Secondary Prevention; D059409:Stroke, Lacunar / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy*; D016896:Treatment Outcome
keywords: Lacunar infarct; cerebral small-vessel disease; prognosis; recurrent stroke